In 2006, a radiation oncologist in Inglewood, California, published a report on building a Lay Patient Navigator Program in collaboration with the @RANDCorporation. #radonc 1/ 🧵acsjournals.onlinelibrary.wiley.com/doi/epdf/10.10…
2/ The focus of this report was to describe how people with cancer who are not as privileged as those living in other areas of Los Angeles might benefit from lay patient navigators.
3/ At the time, it was still an innovative concept to engage lay patient navigators to support people with cancer. Nonetheless, it made a lot of sense to study it.
4/ It was hypothesized there would be benefits to hiring non-healthcare workers to help people living in South Central and Southwestern Los Angeles. Seems like common sense to me.
5/ Input from the community was (appropriately) sought after and helped the program succeed.
6/ This 2006 report is truly inspiring in how much interest the program created in the community and how rare it was for lay patient navigators to lose interest in the opportunity to help.
7/ In good news, buy-in from patients in this part of Los Angeles to work with lay patient navigators was great.
8/ With support from @theNCI, lay patient navigators were also trained to recruit patients for clinical trial enrollment. The navigators soon learned that their involvement wouldn't be a panacea, but it was discovered they could certainly help.
9/ For those who don't know the lead author, he soon became the Chair of Radiation Oncology at UCLA, later became @ASTRO_org president, and eventually received the ASTRO Gold Medal in 2017. You can learn more about his career here: uclahealth.org/providers/mich…
10/ If you want to learn more about him, you can get to know him better on a personal level by reading this interview here: astro.org/About-ASTRO/Hi…
11/ Now, if everyone can refrain from informing him that I highlighted his work on Twitter, that would be great. That includes you, @NehaVapiwala and @ldawsonmd. Thank you. 😀

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More from @DrewMoghanaki

Nov 13
Dear @StephenVLiu, I’d be very careful when suggesting this to audiences who don’t understand the true forces of selection bias. Only 25 pts in the study had a generally good outcome after pneumonectomy. @gotoPER @FordePatrick @DoctorJSpicer 1/
It's always perilous to focus on the outcomes of only 7% enrolled (25/358) in a clinical trial. Yet, it's appropriate to cook the books and state we are actually considering 14% (25/179) who started with chemo-Nivo. 2/
We need to ask ourselves, was the better-than-expected outcome in the 25 pts due to the surgical procedure, a brisk response to chemo-ICB that led to extensive scarring requiring bigger surgery, or the disease biology in these 25 pts before any treatment was delivered? 3/
Read 14 tweets
Nov 12
I wish it wasn't so, but surgical procedures disrupt tumors leading to hematological dissemination and the need for more treatment. Here, a randomized trial reports efforts to reduce this risk. jtcvs.org/article/S0022-… 1/ 🧵 Image
Sadly, contemporary trials show that surgical removal of even the smallest lung cancers (≤2 cm) cannot cure most patients. Note that neither of the DFS curves shows a sign of plateauing. @AltorkiNasser ImageImageImageImage
But what's the alternative? SBRT is promising, keeps the tumor in place, and might lead to better DFS and an earlier plateau. But even if it could, SBRT isn't always safer than surgery. Hence, we need to optimize surgical procedures for whenever its preferred. ImageImageImageImage
Read 8 tweets

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